Organization
THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
Active
Other names
CROASDAILE VILLAGE CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN ERICKSON (ASSISTANT SECRETARY/CORP EXEC DIR)
(919) 384-3001
Entity
Organization
Contact information
Practice address
2600 CROASDAILE FARM PKWY, DURHAM, NC 27705
(919) 384-2571
(919) 384-2649
Mailing address
2600 CROASDAILE FARM PKWY, DURHAM, NC 27705-1331
(919) 384-2571
(919) 384-2649
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34D0973408
CLIA NUMBER
NC
Enumeration date
04/18/2007
Last updated
09/17/2018
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